Flu is a tragic illness. How can we get more people to vaccinate?

Flu (influenza) has traditionally been the underdog of vaccine-preventable diseases. People tend not to worry about the flu too much, and there are various myths about its prevention and the vaccine. It’s true most people experience flu as a mild disease, but many don’t recognise it can be more severe.

Each year flu is estimated to kill at least 3,000 Australians aged over 50 years alone. It took more children’s lives than any other vaccine preventable disease in Australia between 2005-2014, and is the most common vaccine preventable disease that sends Australian children to hospital.

The tragic death of eight-year-old Rosie Andersen from flu this week has followed the recent outbreaks in aged care facilities and subsequent deaths of residents in South Australia, Tasmania and Victoria. A 30-year-old father died earlier this month due to complications from the flu, and now Sarah Hawthorn, who was infected late in her pregnancy, remains in a coma, unaware her baby was safely delivered six weeks ago.

Australian studies have shown the flu vaccine can usually reduce the risk of flu in those who are vaccinated by 40-50%, and by 50-60% for children. Early indications are showing the effectiveness of this year’s flu vaccine may be lower.

Experts are calling for a better vaccine, which is needed. But even a more effective vaccine won’t address all the barriers to uptake.

Who’s most at-risk?

Annual flu vaccination is recommended for any person six months of age or older who wishes to reduce the likelihood of becoming ill with flu. It’s free for certain groups at higher risk of the severe effects of the disease including:

Why don’t they vaccinate?

Researchers have looked at why many people in these groups don’t have their yearly flu vaccine. A common theme emerges - health professionals are not recommending it enough, people aren’t aware they need it, they’re not sufficiently motivated, or they don’t have easy access.

Our research is now looking at the children who end up in hospital with severe flu. We’re trying to better understand the barriers to flu vaccination, along with vaccine efficacy issues.

We’ve heard that not only are health care workers not recommending it enough, some doctors are even recommending against it, as they don’t believe the child is at risk. This is even though over half of children hospitalised from the flu are those without medical risk factors. Other times it’s simple awareness - parents didn’t know their child can receive a flu vaccine if they’re over the age of six months.

Busy lives can mean making time to go to the clinic for a vaccine falls down the list of priorities. A four-year-old in our study was hospitalised only three days before a visit to the clinic had been booked.

Some of the children in our study were not theoretically at high risk of flu and so not in the group where the vaccine is free. This was a major barrier, as it has been in other studies in children and adults. Parents report to us that their child is up-to-date with their scheduled vaccines, but annual flu vaccination is not being ticked off as it’s not on the schedule.

The challenge with flu vaccine is it’s given yearly. In the UK it’s recommended and funded for all children of primary school age using a school-based delivery program and currently between 53-58% of children have it. When this many children are vaccinated there can be indirect protection of others who are not vaccinated because the virus is not able to spread from person to person as easily.

Misconceptions about the flu vaccine

Misconceptions about flu vaccine are also a barrier: that it causes flu, that it’s not effective, that it’s not needed. People might say they never get the flu, not realising symptoms can be mild or not noticed and they can pass it on to the vulnerable. Others reported their belief was that the flu was not a serious disease. Some believed contracting flu “naturally” was likely to provide greater immunity.

Some parents also have concerns about the safety of the flu vaccine. Australians were spooked by a 2010 incident when there was a temporary suspension of flu vaccine for children under five after reports of an increase in the rate of convulsions in children.

The one vaccine found to be the cause (BioCSL/Sequiris Fluvax™) is no longer approved for use in children younger than five, but there are other seasonal flu vaccines children can have. But public and professional confidence is yet to fully recover, despite having reassuring safety data.

People may say they never get the flu so they don’t need the vaccine, but you can pass on the virus without knowing you have it.from www.shutterstock.com

Western Australia has had a free child vaccine program for years which was achieving relatively good coverage, but this dramatically declined after 2010, and coverage languishes at around 15% today. In other words, mud sticks.

How to improve uptake

To improve uptake we first need timely and accurate coverage figures. We now have the capacity to get coverage estimates from the expanded Australian Immunisation Register but these are not yet available.

The vaccine needs to be recommended more often, available more readily, free and recommended as part of the schedule, and myths addressed more effectively.

We need to motivate and support health care workers to implement the recommendations, such as with automated reminders, incentives and performance indicators. Systems need to ensure people can get the vaccine easily - from the GP or other health clinic, the specialist clinic, the antenatal care clinic, or from an Aboriginal or Torres Strait Islander health worker.

Promoting flu vaccine to everyone is important, as is providing ease of access, awareness and opportunity. Although the flu vaccine isn’t perfect, it’s far better than no protection at all.

Updated resources for meningococcal vaccines

Sep 2017 - News

NCIRS has updated its meningococcal fact sheet and developed a new FAQ fact sheet for use by providers. The FAQ in particular provides answers to questions on the use of MenACWY vaccines. Please see links below:

No parent likes seeing their child have injections. Yet, around 93% of parents across Australia protect their children against 15 serious diseases by giving them all the recommended vaccines on the National Immunisation Program Schedule. This success is due in part to the value of combination vaccines, which protect against two or more diseases in one go.

Combination vaccines mean kids need fewer injections overall. By adding several antigens (the part of the germ that stimulates the immune system) together in one vaccine, we can protect kids against up to six diseases in a few shots. These shots are typically given in a series of two or three injections over time.

Our new study released today in JAMA Pediatrics, backs the safety of a four-in-one combination vaccine – designed to protect against measles, mumps, rubella and varicella (chickenpox) and known as the MMRV vaccine. We also show its added benefits in protecting kids by the time they reach pre-school.

Making a combination vaccine typically involves decades of research to ensure the precise balance of “active” components is included, the immune response to each component is effective, and even the slightest change in a vaccine doesn’t change its safety profile.

This video, from the Children’s Hospital of Philadelphia, outlines the steps taken to develop, and evidence behind, combination vaccines.

Once these combination vaccines are used, their safety (as well as the safety of other vaccines) is also actively monitored. One new way we do this in Australia is by monitoring any side-effects in real time. Parents respond to an SMS survey about their child’s recent vaccination, the results of which are collated and posted online.

Too much to handle?

However, some parents question if giving an injection that protects against multiple diseases will overwhelm the immune system or be too much to handle. The answer is “no” for many reasons.

A review into parental concerns about combination vaccinations confirms the moment babies enter the world they are covered in millions of foreign germs. The infant immune system is no longer considered “immature” but is finely tuned to respond to the incredible number of viruses, bacteria and other things it meets early in life. Vaccines contain just a few antigens compared to what babies meet every day.

The researchers estimate that even if 11 vaccines were given to infants at one time, only about 0.1% of the immune system would be “used up”.

Rather than weaken the immune system, or putting it under strain, vaccines train the infant immune system to respond, without causing the terrible consequences of the disease itself. Combination vaccines do the same.

The design of vaccines has been increasingly tailored to leverage this unique biology, including the development of new combination vaccines.

For instance, in 2013, two new combination vaccines – the MMRV vaccine and a combination vaccine against the Haemophilus influenzae type b and meningococcus type c bacteria (Hib-MenC) – were added to Australia’s immunisation schedule, reducing the number of injections babies needed.

Tackling four diseases at once, and measles

Our new study evaluated the impact of one these – the MMRV vaccine – since it was added to the schedule.

Before the MMRV vaccine was introduced, kids were protected against varicella (or chickenpox) with a separate vaccine. And they received their second dose of measles-mumps-rubella (MMR) vaccine at age four years, quite a big gap after their first-birthday dose of MMR.

By introducing this combination MMRV vaccine earlier (at 18 months), our study showed the second dose of vaccine against measles provided early comprehensive protection against this deadly disease.

While the first vaccine dose (given at 12 months) only gives a full immune response in about 90% of children, giving a second dose boosts immunity to more than 95% and also helps to provide longer lasting protection.

The MMRV combination vaccine means more children are protected against chickenpox, mumps and rubella (german measles) before entering pre-school.www.shutterstock.com

Our study showed not only that the percentage of children fully protected against all four diseases is now greater compared with when MMR was separated from the varicella vaccine, it is also occurring at a much earlier age.

“On time” vaccination (within 30 days of the recommended age) has now improved by 13.5% (from 58.9% to 72.4% of children). This means many more children are protected against measles, chickenpox, mumps and rubella (German measles) before entering pre-school.

Tackling four diseases at once, and safety

Another important part of our evaluation was to ensure that introducing this vaccine was safe. If the combination MMRV vaccine is given as the very first dose of measles-containing vaccine in very young children, it causes more cases of fever and a small increase in febrile seizures (a common, usually benign, but frightening convulsion in children) compared with giving the vaccines separately.

Our study examined if using the MMRV shot in the Australian program as the second dose would be linked to an increase in febrile seizures. When we examined all children who came to paediatric hospitals across the country with a febrile convulsion, then looked at what vaccines they had received, we found no increase in febrile seizures associated with this second dose given at 18 months.

In a nutshell

Combination vaccines not only mean fewer visits to the doctor or nurse for injections, they can have other benefits, as well as being safe.

Our study highlights how much information is considered before making any change to the immunisation schedule to introduce combination vaccines, and importantly, how carefully changes to the schedule are monitored and evaluated.

Nationwide on-time protection against measles and other diseases has increased by more than 13 per cent since the introduction of the 4-in-1 measles-mumps-rubella-varicella (MMRV) vaccine for toddlers in 2013, a recent study has revealed.

According to the study, which was carried out by the Paediatric Active Enhanced Disease Surveillance (PAEDS) in conjunction with The National Centre for Immunisation Research and Surveillance (NCIRS), the uptake of on-time measles-containing vaccinations has increased nationally by 13.5% over the last four years, when the MMRV vaccine was first introduced into the National Immunisation Program (NIP).

Prior to July 2013, MMRV vaccines were not used in Australia. Two doses of measles-mumps-rubella (MMR) vaccines were scheduled on the NIP at ages 12-months and 4 years, similar to the US and UK schedules. In an effort to increase the population-level vaccine coverage as well as protection for each individual child, the scheduled age for the second MMR dose was brought forward to 18 months (after the first dose of MMR at 12-months) and replaced with MMRV vaccine.

Deputy Director of Government Programs at the NCIRS and paediatric infectious disease consultant Associate Professor, Kristine Macartney says, “Since implementing the compressed immunisation schedule at ages 12 and 18 months, there has been a 13.5% nationwide improvement in coverage and on-time vaccinations against all four diseases. We have also demonstrated that more children were fully protected against measles at an earlier age.”

“From a family’s perspective, a 4-in-1 vaccine is much more convenient and helps with vaccine acceptance, coverage and ultimately, disease control. Moreover, use of MMRV vaccine as dose 2 of measles containing vaccine (MCV) at the age of 18 months is proven to be a safe way to prevent these diseases. In overseas studies, use of this as dose 1 gave rise to more fever and febrile seizures than had been seen before. However, we have proven that using it under the NIP as dose 2 doesn’t cause seizures,” she added.

Australia was one of the first 4 countries in the World Health Organisation Western Pacific Region to reach measles elimination status, officially declared in March 2014(1). Global efforts to control measles rely on achieving and maintaining high 2-dose vaccine coverage of more than 95% at a country and district level(2). Introducing this 4-in-1 combination vaccine at the younger age of 18 months should help us to maintain that elimination status.

Influenza Vaccine Safety Surveillance Data Update

Jul 2017 - News

In 2017, four age-specific quadrivalent influenza vaccines are available under the National Immunisation Program (NIP). The current safety profile of the 2017 vaccines is reassuring and consistent with expectations. As at 30th July 2017 almost 70,000 people have participated in active influenza vaccine safety surveillance via SMS/email representing a 72% participation rate. Real-time, patient reported data on the safety of Zoster vaccine and Pertussis booster vaccines in children is also available.